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SSL SK SHIP# 226758752 111111111 � �1 �11I �lI 1111111 0 0 6 6 6 6 6 2 4 S K 5 Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1,Generator ID Number 2.P e of 3. m R e P 4.Manifest Trackin Number WASTE MANIFEST TxRelb0eel2r� � � 1006686624 SKS 5.Generator's Name and Mallin Address Generators Site Address�iiif different than mail address) SAFETY-KLEEN SYSTEMS, INC. SAFETY-KLEEN SYMNS, INC. PO BOX 555 5050 SALIDA BLVD SALIDA CA 95368 Generators Phone: 209-545-1011 SALIDA CA 95368 6.T%W&9`r,-urAlame SYSTEMS INC U.S.FPA ID Number TX R000OB 1205 7.Transporter 2 Com an tNaamee U.S.EPA ID Number Wk.B CLEAN ORS ENVIRONMENTAL SVC INC. MAD039322250 8.Designated Facility Name and Site Address SAFETY-KLEEN SYSTEMS, INC. U.S.EPA 10 Number 6000 88TH STREET SACRAMENTO , CA 95828 916-386-4913 CAOOOIBO84517 Facilitys Phone: ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,iD Number, 10.Containers 11.Totai 12.Unit 13.Waste Codes HM and Packing Group(if any}� No, Ty;c Quantity Wt.Nol. 1 l fSt7l lCf]I_1CIIL}1'1LC rL rAklC[1L "5L7 .34 0 Zz NON--RCRA HAZARDOUS WASTE LIQUID DM 6 134 (AQUEOUS PARTS WASHER SOLUTION) 7--Z) 4, 14.Special Handling Instructions and Additional Information TSD:SGA SAL CS6: 24H EMERGENCY#8B8-468-1750-CH/SK/TFI-Contract retained by generator confers agency authori y on initial trans orter to add or substitute additional transporters ongenerator' s behalf. 15, GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeledlplacardad,and are in all respects in proper condition for transport according to applicable intemalionai and national governmental regulations.If export shipment and I am the Primary Exporter,i certify that the contents of this consignment conform to the terms of the attached EPA Acknow edgment of Consent. I certify that the waste minimization statement identified in 40 CFR 26227(a)(if I am a large quantity generator)or(b)(if i am a small quantity generator)is true - GoneratorslOfferot5 PrintedlTy'd Narrog " �� Signature Month Day Year r'll�lV� �it _j36,International Shipments Z11import to U.S. ❑Export from U.S. Port of entrylexit: Transporter signature(for exports only): Date leaving U.S.: u 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Nam Signature Month Day Year IL Z Trans er 2 Printedflyped Name Signature Month Day Year o� �i�ti��l� // ";1 1 „or 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number 18b.Alternate Facility,(or Generator) U.S.EPA ID Number J U ura Facilitys Phone: Q18c.Signature of Alternate Facility(e(Ganerator) Month Day Year Z y19,Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal.and recycling systems) w 1 0 '1?, 2. 14141 3 - T- 20. Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as need in Item 18a PrintedlTyped Name Signature Month.. !c I D y Yea da EPA o -2 2- Prpypy�Iyo �yyp t1oJs'yrYpyr�s h�+e i 494 i”15 '}� DESIGNFACILI TO A's e-MANIFEST SYSTEM